| NPI | 1215211412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 10421) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10421) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2017-12-07 |